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Espinoza G, Justiniano MJ, Rodriguez-Una I, Godin F, Arango A, Villamizar S. Twelve-month outcomes of Kahook dual blade goniotomy combined with cataract surgery in Latino patients. Int Ophthalmol 2024; 44:44. [PMID: 38337081 DOI: 10.1007/s10792-024-03024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate 12 month surgical outcome of Kahook Dual Blade (KDB) goniotomy in combination with cataract surgery in Latino patients with open angle glaucoma (OAG) and ocular hypertension (OHT). METHODS This retrospective study included 45 eyes of 40 patients who underwent KDB goniotomy combined with cataract extraction from January 2016 to September 2020 at two centers in South America. Primary outcome was surgical success defined as ≥ 20% intraocular pressure (IOP) reduction or ≥ 1 medication reduction from preoperative without additional IOP-lowering procedures and an IOP ≥ 5 mmHg or ≤ 21 mmHg. Additionally, we used 2 cutoffs values for success of IOP ≤ 18 and ≤ 15 mmHg. Secondary outcomes included: IOP, medication use, best corrected visual acuity, complications and failure-associated factors. RESULTS Success rates at 12 months with cutoff limits of 21, 18 and 15 mmHg were 84.3%, 75.6% and 58.7%, respectively. At 12 months, mean preoperative IOP significantly decreased from 19.23 ± 0.65 mmHg on 2.3 ± 1.0 medications to 14.33 ± 0.66 mmHg on 0.6 ± 0.9 medications (p < 0.001) , with 62% of eyes free of hypotensive medication. Eyes that developed postoperative IOP spikes showed a higher risk for failure using the cutoff limit of IOP ≤ 18 mmHg with a hazard ratio of 3.6 (95% confidence interval [CI], 1.80-7.13; p < 0.001). There were no serious ocular adverse events. CONCLUSIONS KDB combined with cataract extraction showed safety and efficacy for decreasing IOP in OAG and OHT Latino patients. Additionally, dependence on medications was reduced significantly after surgery.
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Affiliation(s)
- Gustavo Espinoza
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander, Colombia.
- Fundación Oftalmológica de Santander FOSCAL, Ave. El No 23-60, TMS, Cañaveral, Tv. El Bosque Floridablanca, Bucaramanga, Santander, Colombia.
| | | | | | - Fernando Godin
- Grupo de investigación Salud Visual y ocular Unbosque, Universidad del Bosque, Bogotá D.C., Colombia
| | - Andres Arango
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander, Colombia
| | - Sylvia Villamizar
- Centro Oftalmológico Virgilio Galvis, Bucaramanga, Santander, Colombia
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Espaillat A. Outcomes of 60-Degree Nasal Goniotomy for Open Angle Glaucoma. J Glaucoma 2023; 32:e129-e134. [PMID: 37523635 DOI: 10.1097/ijg.0000000000002266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PRCIS Sixty-degree nasal sectoral juxtacanalicular space goniotomy with the single-use Espaillat juxtacanalicular space slider device significantly reduced intraocular pressure and the number of required glaucoma hypotensive medications, with sustained reductions over 24 months. PURPOSE This study analyzed the safety and efficacy of the Espaillat juxtacanalicular space slider during minimally invasive 60-degree nasal sectoral goniotomy for mild-to-moderate open angle glaucoma (OAG). PATIENTS AND METHODS This prospective, observational case series performed at a private clinical practice and outpatient surgery center assessed the eyes of patients with mild-to-moderate OAG who underwent phacoemulsification cataract surgery with 60-degree nasal sectoral goniotomy using the Espaillat juxtacanalicular space slider. The same surgeon performed all procedures. Intraocular pressure, intraocular pressure-lowering drugs, and adverse effects were assessed over 24 months, and a regression analysis of intraocular pressure reduction was performed. Success was defined as (1) A reduction in the intraocular pressure of at least 20% for at least 12 months, compared with the baseline value, and (2) a decrease in the number of medications by at least one for at least 12 months. RESULTS Among 38 eyes, 27 (72%) had moderate glaucoma, and 11 (28%) had mild glaucoma. Postoperatively, intraocular pressure was decreased by 38% at 12 months (mean 13.7±1.7 mmHg), 35% at 18 months (mean 14.4±1.8 mmHg), and 31% at 24 months (mean 15.2±1.9 mmHg). In addition, the number of topical glaucoma medications used decreased from a mean of 1.6 to 0.4 ( P <0.001). The main adverse event was temporary focal corneal edema (29 patients; 76%). CONCLUSIONS Using the Espaillat juxtacanalicular space slider during invasive 60-degree nasal sectoral goniotomy for OAG yielded a significant and sustained reduction in intraocular pressure and reduced the need for glaucoma medications with minimal adverse events.
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Sood S, Heilenbach N, Sanchez V, Glied S, Chen S, Al-Aswad LA. Cost-Effectiveness Analysis of Minimally Invasive Trabecular Meshwork Stents with Phacoemulsification. Ophthalmol Glaucoma 2021; 5:284-296. [PMID: 34563713 DOI: 10.1016/j.ogla.2021.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the costs and effects of implanting trabecular meshwork bypass stents during cataract surgery from a societal perspective in the United States. DESIGN Cost-utility analysis using Markov models and efficacy/safety data from published pivotal or randomized control trials (RCTs) of devices investigated. PARTICIPANTS Patients aged 65 years and older with mild to moderate primary open-angle glaucoma with or without visually significant cataract. METHODS With the use of Markov models, glaucoma progression through 4 glaucoma states (mild, moderate, advanced, severe/blind) and death were simulated over 35 years. The cohort with cataract entered the model and received cataract surgery with or without device implantation. We included a medication management only reference group to calculate total costs and outcomes for those without cataract. Intraocular pressure (IOP) reductions from RCTs were converted to glaucoma state transition probabilities using visual field (VF) mean deviation (MD) decline rates from the Early Manifest Glaucoma Trial. Progressive thinning of the retinal nerve fiber layer (RNFL) on OCT imaging related to IOP control warranted further intervention, including adding medication, selective laser trabeculoplasty (SLT), or incisional glaucoma surgery. We estimated whole costs at Medicare rates and obtained utility values for glaucoma states from previous studies. Incremental costs per quality-adjusted life-year (QALY) gained were evaluated at a QALY threshold of $50 000. One-way deterministic sensitivity analysis, scenario analyses, and probabilistic sensitivity analyses addressed parameter uncertainty and demonstrated model robustness. MAIN OUTCOME MEASURES Total costs, QALY, and incremental cost-effectiveness ratio (ICER). RESULTS Over 35 years in the base case, the Hydrus (Ivantis, Inc.) implanted with cataract surgery arm cost $48 026.13 and gained 12.26 QALYs. The iStent inject (Glaukos Corp.) implanted with cataract surgery arm cost $49 599.86 and gained 12.21 QALYs. Cataract surgery alone cost $54 409.25 and gained 12.04 QALYs. Initial nonsurgical management cost $57 931.22 and gained 11.74 QALY. The device arms dominated or were cost-effective compared with cataract surgery alone within 5 years and throughout sensitivity analyses. The iStent inject arm was cost-effective in 94.19% of iterations in probabilistic sensitivity analyses, whereas the Hydrus arm was cost-effective in 94.69% of iterations. CONCLUSIONS Implanting the Hydrus Microstent or iStent inject during cataract surgery is cost-effective at a conservative QALY threshold.
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Affiliation(s)
- Shefali Sood
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York; New York University, Robert F. Wagner School of Public Service, New York, New York
| | - Noah Heilenbach
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York
| | - Victor Sanchez
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York
| | - Sherry Glied
- New York University, Robert F. Wagner School of Public Service, New York, New York
| | - Sien Chen
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York
| | - Lama A Al-Aswad
- New York University, Grossman School of Medicine, Department of Ophthalmology, New York, New York; New York University, Grossman School of Medicine, Department of Population Health, New York, New York.
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Abstract
PRéCIS:: A large cohort undergoing cataract extraction was retrospectively analyzed to ascertain the degree of real-world intraocular pressure (IOP) reduction in normal eyes and those with glaucoma, and a predictive formula was developed. PURPOSE The purpose of this study was to define the real-world degree of IOP reduction after cataract extraction to guide its role as an isolated intervention for glaucoma. MATERIALS AND METHODS A retrospective analysis was carried out of clinical data collected in 8 clinical sites in the United Kingdom from an electronic medical record system between January 2006 and May 2015. A total of 20,508 eyes without known pathology and 2251 eyes from patients with glaucoma undergoing phacoemulsification and intraocular lens insertion were included. Eyes with intraoperative complications, undergoing additional procedures, axial lengths outside 22 to 26.5 mm, preoperative IOP under 6 mm Hg or over 30 mm Hg, and copathology, except for amblyopia or glaucoma, were excluded. The main outcome measure was the change in preoperative IOP compared with the next recorded visit for up to 12 weeks. RESULTS In eyes without pathology, the mean reduction in IOP was 1.40 mm Hg (±3.74) compared with 1.03 (±5.02), P-value <0.001, in eyes with a diagnosis of glaucoma. A multiple linear regression model identified preoperative IOP, a glaucoma diagnosis, preoperative corrected visual acuity, age, and axial length as determinants of IOP reduction. The model was validated against an independent cohort. CONCLUSIONS We quantify mean IOP reduction achieved in a real-world setting from cataract surgery alone. In glaucomatous eyes where angle closure is not differentiated, phacoemulsification alone yields only a modest reduction of IOP.
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Perez CI, Chansangpetch S, Nguyen A, Feinstein M, Mora M, Badr M, Masis M, Porco T, Lin SC. How to Predict Intraocular Pressure Reduction after Cataract Surgery? A Prospective Study. Curr Eye Res 2019; 44:623-631. [PMID: 30747546 DOI: 10.1080/02713683.2019.1580375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose/Aim: To evaluate the best formula to predict intraocular pressure (IOP) reduction after cataract surgery. Materials and methods: In this prospective longitudinal study, we included consecutive patients with or without glaucoma, either with open or with narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Clinical factors and anterior segment parameters measured with optical biometry and optical coherence tomography were evaluated as preoperative predictors for IOP reduction at 6 months postoperatively. To find the best combinations of predictors, model selection was conducted using least absolute selection and shrinkage operator regression with cross-validation. Results: A total of 156 eyes from 109 patients were enrolled. The mean age of the patients was 74.89 (±8.54) years and the average preoperative IOP was 15.6 (±3.68) mmHg with 0.7 (range 0-4) glaucoma medications. The mean IOP reduction after phaco was 3.1 (±2.49) mmHg at postoperative month 6. After multivariate analysis, preoperative IOP (β = 0.49 [0.4-0.59] P < .0001), gonioscopy score (β = -0.14 [-0.23 to -0.06] P = .0001), anterior chamber depth (β = -0.85 [-1.64 to -0.07] P = 0.033), lens thickness (LT) (β = 0.87 [0.12-1.62] P = .024), and angle open distance 750 (β = -2.2 [-3.96 to -0.44] P = 0.014) were associated with IOP reduction. The best formula to correlate with IOP reduction was -4.76 + (0.46 × preoperative IOP) - (0.42 × LT) - (0.1 × gonioscopy score) - (0.66 × glaucoma status). Conclusion: Different formulas were developed and were able to improve the predictive value of the preoperative IOP. When used in combination, these formulas may help the clinician to know how much IOP reduction to expect after cataract surgery at 6 months postoperatively.
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Affiliation(s)
- Claudio I Perez
- a Department of Ophthalmology , University of California , San Francisco , CA , USA.,b Fundación Oftalmológica los Andes , Universidad de los Andes , Santiago , Chile
| | - Sunee Chansangpetch
- a Department of Ophthalmology , University of California , San Francisco , CA , USA.,c Faculty of Medicine , Chulalongkorn University, and King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Anwell Nguyen
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Max Feinstein
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Marta Mora
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Mai Badr
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Marisse Masis
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Travis Porco
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Shan C Lin
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
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Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification. J Glaucoma 2018; 27:622-626. [DOI: 10.1097/ijg.0000000000000976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coh P, Moghimi S, Chen RI, Hsu CH, Masís Solano M, Porco T, Lin SC. Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Glaucomatous Versus Nonglaucomatous Eyes. Invest Ophthalmol Vis Sci 2017; 57:2593-9. [PMID: 27163773 PMCID: PMC4868101 DOI: 10.1167/iovs.16-19384] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the relationship between lens position parameters and intraocular pressure (IOP) reduction after cataract surgery in patients with primary open-angle glaucoma (POAG) and in nonglaucomatous patients. Methods The main outcomes of this prospective study were percent and absolute IOP change, which were calculated using the preoperative IOP and the IOP 4 months after cataract surgery in POAG and nonglaucomatous eyes. Lens position (LP), defined as anterior chamber depth (ACD) + one-half lens thickness (LT), was assessed preoperatively using parameters from optical biometry. Preoperative IOP, axial length (AL), ACD, LT, relative lens position (RLP), and the ratio of preoperative IOP to ACD (PD ratio) were also evaluated as potential predictors of IOP change. Results Four months postoperatively, the average IOP reduction was 2.80 ± 3.83 mm Hg (15.79%) from the preoperative mean of 14.73 ± 2.89 mm Hg for nonglaucomatous eyes. The average IOP reduction was 2.66 ± 2.07 mm Hg (16.98%) from the preoperative mean of 14.86 ± 2.97 mm Hg for POAG eyes. Preoperative IOP, sex, AL, ACD, PD ratio, and LP predicted IOP change in nonglaucomatous eyes. Preoperative IOP and PD ratio predicted IOP change in POAG eyes. Conclusions Intraocular pressure reduction after phacoemulsification cataract surgery in nonglaucomatous eyes is significantly greater in more anteriorly positioned lenses. Though it did not reach statistical significance in patients with glaucoma, the association of LP with IOP reduction is in the same direction as in nonglaucomatous patients where smaller LP appears to predict greater IOP reduction. Lens position is a simple, easily calculable, accurate, and widely available parameter, which clinicians can potentially utilize in managing glaucoma.
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Affiliation(s)
- Paul Coh
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
| | - Sasan Moghimi
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 2Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rebecca I Chen
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 3Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Chi-Hsin Hsu
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 4Department of Ophthalmology, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Marissé Masís Solano
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 5Department of Ophthalmology, Costa Rica University, Clinica Oftalmologica/CCSS, San Jose, Costa Rica
| | - Travis Porco
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, United States
| | - Shan C Lin
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
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Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Safety of deferring review after uneventful cataract surgery until 2 weeks postoperatively. J Cataract Refract Surg 2017; 41:2755-64. [PMID: 26796457 DOI: 10.1016/j.jcrs.2015.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED We conducted a systematic review and metaanalysis to provide evidence-based recommendations on the value of early postoperative review. We identified 3 randomized controlled trials (RCTs) that compared patients seen on the first postoperative day with those reviewed at 2 weeks; the 3 studies comprised 886 patients. The risk for postoperative complications was lower when review was deferred 2 weeks because of early transient pressure spikes. There was no difference in the number of unscheduled visits during the first 2 weeks postoperatively or the visual acuity at follow-up. No safety was gained by reviewing patients on the first postoperative day, and we recommend that routine early postoperative control can be omitted in nonglaucomatous patients after uneventful surgery if symptomatic patients are seen by an ophthalmologist as needed. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Line Kessel
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark.
| | - Jens Andresen
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Ditte Erngaard
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Per Flesner
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Britta Tendal
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
| | - Jesper Hjortdal
- From the Department of Ophthalmology (Kessel), Copenhagen University Hospital Glostrup, Glostrup, the Danish Health and Medicines Authorities (Kessel, Tendal) and the Nordic Cochrane Center (Tendal), Rigshospitalet, Copenhagen, the Skanderborg Eye Clinic (Andresen), Skanderborg, the Department of Ophthalmology (Erngaard), Næstved Hospital, Næstved, the Odense Eye Clinic (Flesner), Odense, and the Department of Ophthalmology (Hjortdal), Aarhus University Hospital NBG, Aarhus, Denmark
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DeVience E, Chaudhry S, Saeedi OJ. Effect of intraoperative factors on IOP reduction after phacoemulsification. Int Ophthalmol 2016; 37:63-70. [PMID: 27061903 DOI: 10.1007/s10792-016-0230-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/04/2016] [Indexed: 11/29/2022]
Abstract
The purpose of the study was to determine the independent predictors of long-term intraocular pressure (IOP) reduction after cataract surgery with phacoemulsification. This is a retrospective review of uncomplicated cataract surgeries from 2006 to 2008 at the Baltimore VA Medical Center with longitudinal follow-up. Demographic, clinical, biometric, and intraoperative variables including phacoemulsification parameters were recorded. Univariate and multivariate linear regression were used to analyze the relationship between these variables and postoperative IOP, which was the outcome variable. Analysis was performed in 115 eyes of 115 patients who underwent uncomplicated phacoemulsification during the study period. There was an average postoperative IOP reduction through 12, 24, and 36 months of -1.7 ± 3.1, -1.5 ± 3.8, and -1.3 ± 2.6 mmHg, respectively. Higher preoperative IOP (P < 0.001), a more anterior relative lens position (P < 0.05), and longer phaco time (P < 0.05) were significantly associated with greater postoperative decrease in IOP using univariate analysis. Using multivariate analysis, preoperative IOP (P < 0.001), and phaco time (P = 0.038) were associated with greater postoperative IOP reduction through 24 months. Phaco time is independently associated with IOP reduction after adjusting for age and preoperative IOP. Higher preoperative IOP is associated with a greater IOP-lowering effect after phacoemulsification.
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Affiliation(s)
- Eva DeVience
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St, Suite 470, Baltimore, MD, 21201, USA
| | - Sona Chaudhry
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St, Suite 470, Baltimore, MD, 21201, USA.
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Hsu CH, Kakigi CL, Lin SC, Wang YH, Porco T, Lin SC. Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Nonglaucomatous Patients With Open Angles. Invest Ophthalmol Vis Sci 2015; 56:7807-7813. [PMID: 26650901 DOI: 10.1167/iovs.15-17926] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose To evaluate the relationship between lens position parameters and intraocular pressure (IOP) reduction after cataract surgery in nonglaucomatous eyes with open angles. Methods The main outcome of the prospective study was percentage of IOP change, which was calculated using the preoperative IOP and the IOP 4 months after cataract surgery in nonglaucomatous eyes with open angles. Lens position (LP), defined as anterior chamber depth (ACD) + 1/2 lens thickness (LT), was assessed preoperatively using parameters from optical biometry. Preoperative IOP, central corneal thickness, ACD, LT, axial length (AXL), and the ratio of preoperative IOP to ACD (PD ratio) were also evaluated as potential predictors of percentage of IOP change. The predictive values of the parameters we found to be associated with the primary outcome were compared. Results Four months after cataract surgery, the average IOP reduction was 2.03 ± 2.42 mm Hg, a 12.74% reduction from the preoperative mean of 14.5 ± 3.05 mm Hg. Lens position was correlated with IOP reduction percentage after adjusting for confounders (P = 0.002). Higher preoperative IOP, shallower ACD, shorter AXL, and thicker LT were significantly associated with percentage of IOP decrease. Although not statistically significant, LP was a better predictor of percentage of IOP change compared to PD ratio, preoperative IOP, and ACD. Conclusions The percentage of IOP reduction after cataract surgery in nonglaucomatous eyes with open angles is greater in more anteriorly positioned lenses. Lens position, which is convenient to compute by basic ocular biometric data, is an accessible predictor with considerable predictive value for postoperative IOP change.
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Affiliation(s)
- Chi-Hsin Hsu
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 2Department of Ophthalmology, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Caitlin L Kakigi
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
| | - Shuai-Chun Lin
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 4Department of Medical Research, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Travis Porco
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, United States
| | - Shan C Lin
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
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Zetterström C, Behndig A, Kugelberg M, Montan P, Lundström M. Changes in intraocular pressure after cataract surgery: Analysis of the Swedish National Cataract Register Data. J Cataract Refract Surg 2015; 41:1725-9. [DOI: 10.1016/j.jcrs.2014.12.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/21/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
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Melancia D, Abegão Pinto L, Marques-Neves C. Cataract surgery and intraocular pressure. Ophthalmic Res 2015; 53:141-8. [PMID: 25765255 DOI: 10.1159/000377635] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/02/2015] [Indexed: 11/19/2022]
Abstract
Cataract surgery is one of the most performed surgeries in the developed world. In addition to its significant impact on visual acuity, phacoemulsification has been hailed as a potential intraocular pressure (IOP)-lowering procedure. While current evidence suggests an overall significant and sustained decrease in IOP to exist after cataract surgery, the specific ocular characteristics that could help predict which patients are likely to benefit from this IOP-lowering effect remain unclear. This definition is important in glaucoma patients if this surgery is to be used in the treatment for this disease. Our review aims to summarize the literature on the subject, depicting possible mechanisms behind this IOP decrease, which type of patients are more likely to benefit from this surgery for IOP-lowering purposes and ultimately help optimizing disease management for the increasing number of patients with concomitant glaucoma and cataract.
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Affiliation(s)
- Diana Melancia
- Department of Pharmacology and Neurosciences, Lisbon University, Lisbon, Portugal
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Bayhan HA, Bayhan SA, Gürdal C. Long-term increase in subfoveal choroidal thickness after surgery for senile cataracts. Am J Ophthalmol 2015; 159:406-7. [PMID: 25542557 DOI: 10.1016/j.ajo.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 10/27/2014] [Accepted: 11/01/2014] [Indexed: 11/15/2022]
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